Grief Is Not a Mental Illness

We moderns seem determined to suppress all unhappiness with one exception: grief. The intense sadness following loss of a loved one still occupies a warm spot in our culture. We want that pain protected from the deadening analgesics of pharmaceuticals.

That explains the American Psychiatric Association's decision to retreat from a plan to categorize ordinary grief as an adjustment disorder. Some wanted to classify a response to significant loss -- deep sadness, insomnia, poor appetite, inability to concentrate, crying -- lasting more than two weeks as a depression rather than normal grief, drawing fire from both mental-health professionals and ordinary folk.

The proposal to "medicalize" grief arose as the association was updating the bible for identifying conditions of the mind, the Diagnostic and Statistical Manual of Mental Disorders. Insurers use DSM criteria for deciding whether to cover mental health services. This and other suggestions to expand the definition of mental illnesses were controversial: They could boost health care spending considerably and/or shortchange the care of those with serious conditions. But that's another story.

Diagnosing bereavement as depression, even though the two have much in common, seemed dehumanizing. Grief is widely seen as a natural reaction to a part of the human condition most of us will experience. Anyone who has lost a sibling, spouse, child, parent or good friend knows that two weeks ain't nothing. Therapists have long advised patients that rather than avoiding the pain of grief through overwork or other distractions, one has to "go through it." As the English hymn writer William Cowper said over two centuries ago, "Grief is its own med'cine."

Our culture has inflated the causes of grief perhaps too enthusiastically in recent decades. It used to be uniquely tied to the death of a beloved. Now it covers other kinds of loss -- of one's health, a marriage, a job. These are all painful events, but one can learn to work around physical impairment, communicate with an ex-spouse or get another job. Death is a permanent thing.

That's not to dismiss the value of counseling following a death or the other aforementioned losses. It's just that framing failure to snap back from bereavement in a matter of weeks or even months as a mental disorder seems really off the mark.

Religion may understand the nature of this beast better than the scientists. Catholics hold masses for the dead and wakes, a vigil over the body of the deceased. Different churches use different liturgical colors for funerals. In the Episcopal and other churches, the color is white. Jews insist on immediate burials, but may practice shiva, whereby friends and relatives gradually help the grief-stricken back into society. They cover mirrors. Hindus in mourning cover all religious pictures. Muslims offer prayers for the forgiveness of the deceased.

Victorians observed elaborate rules for somber dress, which lighten as time goes on. In her 1922 classic, "Etiquette," Emily Post offered over a dozen pages of instructions, from drawing the blinds in the sick room immediately after death to the proper mourning clothes for the country in summer.

What all these rituals do is wrap mourners in the comfort of deep tradition, making the loss seem part of a natural cycle. And they provide company to those in pain. Of course, a therapist can also offer that human support and perspective while keeping a medical eye on the aggrieved person's health.

And that's about it. This is something science cannot cure. It's not strep throat. Grief is painful, but it's also precious. Once again, the most effective way to get through it is to go through it.

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